Diagnostic method

ABSTRACT

The present invention concerns a method for the detection or monitoring of cancer using a biological sample selected from blood, plasma, serum, saliva, urine from an individual, said method comprising:
         (a) obtaining DNA from the said biological sample;   (b) digesting the DNA sample with one or more methylation-sensitive restriction enzymes;   (c) quantifying or detecting a DNA sequence of interest after step (b), wherein the target sequence of interest contains at least two methylation-sensitive restriction enzyme recognition sites; and   (d) comparing the level of the DNA sequence from the individual to a normal standard, to detect, prognosticate or monitor cancer.

CROSS REFERENCE TO RELATED PATENT APPLICATION

This application claims the benefit of the filing date of U.S. provisional patent application 60/847,499, filed Sep. 27, 2006, the disclosure of which is herein incorporated by reference.

FIELD OF THE INVENTION

The present invention relates to methods for diagnosis, prognosis or monitoring of cancer in an individual, in particular using the differential methylation patterns in genes associated with cancers.

BACKGROUND TO THE INVENTION

It is well known that many tumor suppressor genes are methylated in tumor cells. As such, the use of methylation markers has been suggested for the detection or monitoring of cancer in patients. A number of different methods have been proposed for detection of these methylated sequences.

Methylation specific PCR (MSP) is the most commonly used method for detecting methylated or unmethylated DNA. MSP involves the step of bisulfite conversion. Sodium bisulfite is used to deaminate cytosine to uracil while leaving 5-methyl-cytosine intact. Methylation-specific PCR uses PCR primers targeting the bisulfite induced sequence changes to specifically amplify either methylated or unmethylated alleles. Bisulfite conversion destroys about 95% of the DNA. Since DNA concentrations are typically very low in the serum or plasma, a 95% reduction in DNA results in a detection rate of less than 50%.

Alternative methods use restriction enzymes that digest specifically either the methylated or unmethylated DNA. Enzymes that cut specifically methylated DNA are rare. However, enzymes that cut specifically unmethylated DNA are more readily available. Detection methods then establish whether digestion has occurred or not, and thus depending on the specificity of the enzyme used, allows detection of whether the underlying DNA was methylated or unmethylated and thus associated with cancer or not.

Methylation-sensitive enzyme digestion has been previously proposed. For example, Silva et al, British Journal of Cancer, 80:1262-1264, 1999 conducted methylation-sensitive enzyme digestion followed by PCR. However, as noted by the authors Yegnasubramanian et al, Nucleic Acids Research, Vol. 34, No. 3, 2006 e19, such methods are plagued by the number of false-positives that are generated.

The present invention seeks to provide enhanced methods of methylation-sensitive detection which eliminate or reduce false positives and/or false negatives.

SUMMARY OF THE INVENTION

In accordance with the present invention, there is provided a method for the detection or monitoring of cancer using a biological sample selected from blood, plasma, serum, saliva, urine from an individual, said method comprising:

-   -   (a) obtaining DNA from the said biological sample;     -   (b) digesting the DNA sample with one or more         methylation-sensitive restriction enzymes;     -   (c) quantifying or detecting a DNA sequence of interest after         step (b), wherein the target sequence of interest contains at         least two methylation-sensitive restriction enzyme recognition         sites; and     -   (d) comparing the level of the DNA sequence from the individual         to a normal standard, to detect, prognosticate or monitor         cancer.

In a preferred aspect of the present invention, the polymerase chain reaction is used in step (c). Preferably, the methylation-sensitive restriction enzyme recognises DNA sequences which have not been methylated. The target sequence is a sequence susceptible to methylation in cancer patients so that an unmethylated target sequence in a normal patient is digested and is not amplified by the polymerase chain reaction, whereas in a cancer patient, the target sequence is methylated and is not digested by the enzyme and can subsequently be quantified or detected, for example using the polymerase chain reaction.

The methods of the present invention can be used to predict the susceptibility to cancer of the individual, to assess the stage of cancer in the individual, to predict the likelihood of overall survival for the individual, to predict the likelihood of recurrence for the individual or to assess the effectiveness of treatment in the individual.

In accordance with another aspect of the present invention, there is provided a method for the detection or monitoring of cancer using a biological sample selected from blood, plasma, serum, saliva, urine from an individual, said method comprising:

(a) obtaining DNA from the said biological sample;

(b) digesting the DNA sample with one or more methylation-sensitive restriction enzymes;

(c) quantifying or detecting a DNA sequence of interest after step (b) wherein the DNA sequence is a sequence comprising part or all of RASSF1A; and

(d) comparing the level of the DNA sequence from the individual to a normal standard, to detect, prognosticate or monitor cancer.

In accordance with a further aspect of the invention, there is provided probes, primers and kits for use in the method of the invention. In particular, there is provided:

a detectably-labelled probe for the detection or monitoring of cancer in a biological sample selected from blood, plasma, serum, saliva, urine from an individual, which comprises the sequence shown in SEQ ID NO: 4;

a set of primers for the detection or monitoring of cancer in a biological sample selected from blood, plasma, serum, saliva, urine from an individual, which comprises a primer comprising the sequence shown in SEQ ID NO: 2 and a primer comprising the sequence shown in SEQ ID NO: 3;

a kit for the detection or monitoring of cancer in a biological sample selected from blood, plasma, serum, saliva, urine from an individual, which comprises the probe of the invention and the set of primers of the invention

a detectably-labelled probe for use as a control during the detection or monitoring of cancer in a biological sample selected from blood, plasma, serum, saliva, urine from an individual, which comprises the sequence shown in SEQ ID NO: 7;

a set of primers for use as a control during the detection or monitoring of cancer in a biological sample selected from blood, plasma, serum, saliva, urine from an individual, which comprises a primer comprising the sequence shown in SEQ ID NO: 5 and a primer comprising the sequence shown in SEQ ID NO: 6; and

a kit for use as a control during the detection or monitoring of cancer in a biological sample selected from blood, plasma, serum, saliva, urine from an individual, which comprises the control probe of the invention and the set of control primers of the invention.

DESCRIPTION OF THE FIGURES

FIG. 1: concentration of methylated RASSF1A in patients' plasma.

FIG. 2: changes of plasma methylated RASSF1A levels after surgical resection of hepatocellular carcinoma (HCC).

FIG. 3: methylated RASSF1A sequence concentration in plasma prior to surgical resection is predictive of patient survival after surgical resection.

FIG. 4: methylated RASSF1A sequence concentration in plasma post-surgical resection is predictive of patients survival after surgical resection.

FIG. 5: concentration of methylated RASSF1A detected in the plasma of nasopharangeal carcinoma (NPC) patients correlated with Epstein-Barr virus (EBV) DNA concentration.

FIG. 6: Genomic sequence of the promoter and the first exon of the RASSF1A gene (SEQ ID NO: 1). The recognition sequence of the methylation-sensitive restriction enzyme BstUI is underlined and the target sequence for PCR detection is highlighted in bold. There are 5 BstUI enzyme restriction sites in the target sequence.

DETAILED DESCRIPTION OF THE INVENTION

The present invention provides a method to assess, diagnose, prognosticate or monitor the presence or progression of tumors in an individual. The method involves the use of a methylation-sensitive restriction enzyme to digest DNA sequences. DNA sequences of interest are selected which contain at least two restriction sites which may or may not be methylated. The method is preferably carried out with methylation-sensitive restriction enzymes which preferentially cleave unmethylated sequences compared to methylated sequences. Methylated sequences remain undigested and are detected. Digestion of unmethylated sequences at at least one of the methylation-sensitive restriction enzyme sites results in the target sequence not being detected or amplifiable. Thus a methylated sequence can be distinguished from an unmethylated sequence. In one embodiment of the invention, the quantity of uncut target sequence detected in a biological sample, e.g. plasma or serum of cancer patients is higher than that demonstrated in a biological sample of the same type of healthy or cancer-free individuals since the target sequences are more highly methylated in cancer patients than healthy individuals.

In the alternative, restriction enzymes which cut methylated DNA can be used. Unmethylated DNA sequences are not digested and can be detected. In another embodiment of this invention, lower quantifies of the uncut DNA sequence are detected in a biological sample, e.g. plasma, or serum of cancer patients when compared with that demonstrated in a biological sample of the same type in cancer-free individuals.

In a preferred embodiment according to the present invention, the target sequence is detected by amplification by PCR. Real-time quantitative PCR can be used. Primer sequences are selected such that at least two methylation-sensitive restriction enzyme sites are present in the sequence to be amplified using such primers. The methods in accordance with the present invention do not use sodium bisulfite. Amplification by a suitable method, such as PCR, is used to detect uncut target sequence, and thus to identify the presence of methylated DNA which has not been cut by restriction enzymes.

In accordance with the present invention, any suitable methylation-sensitive restriction enzyme can be used. Examples of methylation-sensitive restriction enzymes that cut unmethylated DNA are listed in Table I below.

TABLE I Examples of methylation-sensitive restriction enzymes: Effect of CpG Recognition methylation  on Enzyme sequence enzyme restriction* AatII GACGTC blocked AjiI CACGTC blocked BstUI, Bsh1236I CGCG blocked Bsh12851 CGRYCG blocked BshTI ACCGGT blocked Bsp68I TCGCGA blocked Bsp119I TTCGAA blocked Bsp143II RGCGCY blocked Bsu15I ATCGAT blocked CseI GACGC blocked Cfr10I RCCGGY blocked Cfr42I CCGCGG blocked CpoI CGGWCCG blocked Eco47III AGCGCT blocked Eco52I CGGCCG blocked Eco72I CACGTG blocked Eco105I TACGTA blocked EheI GGCGCC blocked Esp3I CGTCTC blocked FspAI RTGCGCAY blocked HhaI; Hin6I GCGC blocked Hin1I GRCGYC blocked HpaII CCGG blocked Kpn2I TCCGGA blocked MluI ACGCGT blocked NotI GCGGCCGC blocked NsbI TGCGCA blocked PauI GCGCGC blocked PdiI GCCGGC blocked P112311 CGTACG blocked Pfl23II CGTACG blocked Ppu21I YACGTR blocked Psp1406I AACGTT blocked PvuI CGATCG blocked SalI GTCGAC blocked SgsI GGCGCGCC blocked SmaI CCCGGG blocked SmuI CCCGC blocked SsiI CCGC blocked TaiI ACGT blocked TauI GCSGC blocked The letter codes in the recognition sequences represent different combinations of nucleotides and are summarised as follows: R = G or A; Y = C or T; W = A or T; M = A or C; K = G or T; S = C or G; H = A, C or T; V = A, C or G; B = C, G or T; D = A, G or T; N = G, A, T or C. The CpG dinucleotide(s) in each recognition sequence is/are underlined. The cytosine residues of these CpG dinucleotides are subjected to methylation. *The methylation of the cytosine of the CpG dinucleotides in the recognition sequence would prevent enzyme cutting of the target sequence.

The target sequence includes two or more methylation-sensitive restriction enzyme sites. Such sites may be recognised by the same or different enzymes. However, the sites are selected so that at least two sites in each sequence are digested when unmethylated when using enzymes which preferentially cleave unmethylated sequences compared to methylated sequences.

In a less preferred embodiment the target sequence contains at least two sites which are cut or cleaved by restriction enzymes which preferentially cleave methylated sequences. The two or more sites may be cleaved by the same or different enzymes.

Any suitable DNA methylation marker may be used in accordance with the present invention. Such DNA methylation markers are those where the selected sequence shows a different methylation pattern in cancer patients compared to normal individuals. Suitable markers are selected such that the sequence to be amplified contains at least two methylation-sensitive restriction enzyme sites. Generally such methylation markers are genes where promoter and/or encoding sequences are methylated in cancer patients. Preferably the selected sequences are not methylated or are methylated to a lesser extent in non-cancer or cancer-free individuals.

Suitable DNA methylation markers include, for example, RASSF1A. Indeed, RASSF1A has proved to be particularly effective for use in detection or monitoring of cancer in an individual. Thus, in accordance with an alternative aspect of the present invention, there is provided a method for the detection or monitoring of cancer using a biological sample selected from blood, plasma, serum, saliva, urine from an individual, said method comprising:

(a) obtaining DNA from the said biological sample;

(b) digesting the DNA sample with one or more methylation-sensitive restriction enzymes;

(c) quantifying or detecting a DNA sequence of interest after step (b) wherein the DNA sequence is a sequence comprising part or all of RASSF1A; and

(d) comparing the level of the DNA sequence from the individual to a normal standard, to detect, prognosticate or monitor cancer.

The tumor types associated with RASSF1A promoter hypermethylation are listed in Table II below.

TABLE II Frequencies of RASSF1A promoter hypermethylation in different types of cancers (ordered in descending frequency): Frequencies of RASSF1A promoter Cancer types hypermethylation References Liver  93%-100% (1-4) Breast 49%-95% (5-8) Lung (small cell) 79%-88% (9, 10) Prostate 71%-83% (11-13) Melanoma 41%-75% (14, 15) Pancreas 64% (16) Kidney 36%-64% (17-19) Bladder 47%-60% (20, 21) Colon 12%-45% (19, 22-24) Ovary 30%-40% (19, 25, 26) Lung (non-small cell) 28%-40% (9, 27, 28)

REFERENCES FOR TABLE II

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Burbee D G, Forgacs E, Zochbauer-Muller S, Shivakumar L, Fong         K, Gao B, et al. Epigenetic inactivation of RASSF1A in lung and         breast cancers and malignant phenotype suppression. J Natl         Cancer Inst 2001; 93:691-9.     -   6. Mehrotra J, Vali M, McVeigh M, Kaminsky S L, Fackler M J,         Lahti-Domenici J, et al. Very high frequency of hypermethylated         genes in breast cancer metastasis to the bone, brain, and lung.         Clin Cancer Res 2004; 10:3104-9.     -   7. Fackler M J, McVeigh M, Evron E, Garrett E, Mehrotra J,         Polyak K, et al. DNA methylation of RASSF1A, HIN-1, RAR-beta,         Cyclin D2 and Twist in in situ and invasive lobular breast         carcinoma. Int J Cancer 2003; 107:970-5.     -   8. Yeo W, Wong W L, Wong N, Law B K, Tse G M, Zhong S. High         frequency of promoter hypermethylation of RASSF1A in tumorous         and non-tumourous tissue of breast cancer. Pathology 2005;         37:125-30.     -   9. Grote H J, Schmiemann V, Geddert H, Bocking A, Kappes R,         Gabbert H E, et al. Methylation of RAS association domain family         protein 1A as a biomarker of lung cancer. Cancer 2006;         108:129-34.     -   10. Dammann R, Takahashi T, Pfeifer G P. The CpG island of the         novel tumor suppressor gene RASSF1A is intensely methylated in         primary small cell lung carcinomas. Oncogene 2001; 20:3563-7.     -   11. Jeronimo C, Henrique R, Hoque M O, Mambo E, Ribeiro F R,         Varzim G, et al. A quantitative promoter methylation profile of         prostate cancer. Clin Cancer Res 2004; 10:8472-8.     -   12. Kang G H, Lee S, Lee H J, Hwang K S. Aberrant CpG island         hypermethylation of multiple genes in prostate cancer and         prostatic intraepithelial neoplasia. J Pathol 2004; 202:233-40.     -   13. Liu L, Yoon J H, Dammann R, Pfeifer G P. Frequent         hypermethylation of the RASSF1A gene in prostate cancer.         Oncogene 2002; 21:6835-40.     -   14. Spugnardi M, Tommasi S, Dammam R, Pfeifer G P, Hoon D S.         Epigenetic inactivation of RAS association domain family protein         1 (RASSF1A) in malignant cutaneous melanoma. Cancer Res 2003;         63:1639-43.     -   15. Marini A, Mirmohammadsadegh A, Nambiar S, Gustrau A, Ruzicka         T, Hengge U R. Epigenetic inactivation of tumor suppressor genes         in serum of patients with cutaneous melanoma. J Invest Dermatol         2006; 126:422-31.     -   16. Dammann R, Schagdarsurengin U, Liu L, Otto N, Gimm O, Dralle         H, et al. Frequent RASSF1A promoter hypermethylation and K-ras         mutations in pancreatic carcinoma. Oncogene 2003; 22:3806-12.     -   17. Tokinaga K, Okuda H, Nomura A, Ashida S, Furihata M,         Shuin T. Hypermethylation of the RASSF1A tumor suppressor gene         in Japanese clear cell renal cell carcinoma. Oncol Rep 2004;         12:805-10.     -   18. Dulaimi E, Ibanez de Caceres I, Uzzo R G, Al-Saleem T,         Greenberg R E, Polascik T J, et al. Promoter hypermethylation         profile of kidney cancer. Clin Cancer Res 2004; 10:3972-9.     -   19. Yoon J H, Dammann R, Pfeifer G P. Hypermethylation of the         CpG island of the RASSF1A gene in ovarian and renal cell         carcinomas. Int J Cancer 2001; 94:212-7.     -   20. Lee M G, Kim H Y, Byun D S, Lee S J, Lee C H, Kim J I, et         al. Frequent epigenetic inactivation of RASSF1A in human bladder         carcinoma. Cancer Res 2001; 61:6688-92.     -   21. Chan M W, Chan L W, Tang N L, Lo K W, Tong J H, Chan A W, et         al. Frequent hypermethylation of promoter region of RASSF1A in         tumor tissues and voided urine of urinary bladder cancer         patients. Int J Cancer 2003; 104:611-6.     -   22. van Engeland M, Roemen G M, Brink M, Pachen M M, Weijenberg         M P, de Bruine A P, et al. K-ras mutations and RASSF1A promoter         methylation in colorectal cancer. Oncogene 2002; 21:3792-5.     -   23. Wagner K J, Cooper W N, Grundy R G, Caldwell G, Jones C,         Wadey R B, et al. Frequent RASSF1A tumour suppressor gene         promoter methylation in Wilms' tumour and colorectal cancer.         Oncogene 2002; 21:7277-82.     -   24. Xu X L, Yu J, Zhang H Y, Sun M H, Gu J, Du X, et al.         Methylation profile of the promoter CpG islands of 31 genes that         may contribute to colorectal carcinogenesis. World J         Gastroenterol 2004; 10:3441-54.     -   25. Makarla P B, Saboorian M H, Ashfaq R, Toyooka K O, Toyooka         S, Minna J D, et al. Promoter hypermethylation profile of         ovarian epithelial neoplasms. Clin Cancer Res 2005; 11:5365-9.     -   26. Dhillon V S, Aslam M, Husain S A. The contribution of         genetic and epigenetic changes in granulosa cell tumors of         ovarian origin. Clin Cancer Res 2004; 10:5537-45.     -   27. 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Other preferred tumor suppressor genes showing hypermethylation in tumors are listed in Table III.

TABLE III Examples of tumor suppressor genes which promoter regions are frequently inactivated by methylation in cancers: Tumor Types of cancer in which the suppressor gene may be aberrantly gene methylated References APC colorectal, breast, head and (1-13) neck, esophagus, bladder, prostate, stomach, lung, kidney DAP- pancreas, stomach, lung, (9, 10, 14-19) kinase colorectal, breast, cervix, nasopharynx E-cadherin breast, lung, stomach, (8, 20-27) colorectal, prostate, bladder, cervix, kidney GSTPI lung, stomach, bladder, (8, 9, 11, 12, 28-31) prostate, breast, cervix hMLHI stomach, colorectal, cervix, (6, 9, 16, 21, 31-34) liver, esophagus, lung, ovary, prostate MGMT lung, colorectal, bladder, (8, 11, 13, 15-17, 28, cervix, breast, esophagus, 31, 35, 36) prostate, nasopharynx, kidney NORE1A kidney, lung, breast, colon (37-39) p14 colorectal, bladder, (11, 13, 16, 19, 40-42) nasopharynx, kidney, stomach, breast p15 bladder, nasopharynx, kidney, (7, 11, 19, 27, 43-46) multiple myeloma, colorectal, lung, ovary, stomach P16INK4a lung, stomach, bladder, cervix, (8, 9, 11, 15, 17, 18, nasopharynx, breast, prostate, 27, 28, 35, 43, 44, 47-49) kidney, liver, colorectal, pancreas, leukemia, multiple myeloma, thyroid RARbeta lung, breast, nasopharynx, (8, 12, 13, 19, 23, 30, prostate, kidney, stomach 35, 50) SOCS1 colorectal, leukemia, stomach, (51-57) ovary, liver, pancreas Rb retinoblastoma, lung, (58-61) esophagus, stomach VHL kidney (13, 62)

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Promoter hypermethylation is the predominant mechanism in         hMLH1 and hMSH2 deregulation and is a poor prognostic factor in         nonsmoking lung cancer. Clin Cancer Res 2005; 11:5410-6.     -   34. Gifford G, Paul J, Vasey P A, Kaye S B, Brown R. The         acquisition of hMLH1 methylation in plasma DNA after         chemotherapy predicts poor survival for ovarian cancer patients.         Clin Cancer Res 2004; 10:4420-6.     -   35. Munot K, Bell S M, Lane S, Horgan K, Hanby A M, Speirs V.         Pattern of expression of genes linked to epigenetic silencing in         human breast cancer. Hum Pathol 2006; 37:989-99.     -   36. Baumann S, Keller G, Puhringer F, Napieralski R, Feith M,         Langer R, et al. The prognostic impact of O6-Methylguanine-DNA         Methyltransferase (MGMT) promotor hypermethylation in esophageal         adenocarcinoma. Int J Cancer 2006; 119:264-8.     -   37. Hesson L, Dallol A, Minna J D, Maher E R, Latif F. NORE1A, a         homologue of RASSF1A tumour suppressor gene is inactivated in         human cancers. Oncogene 2003; 22:947-54.     -   38. Irimia M, Fraga M F, Sanchez-Cespedes M, Esteller M. CpG         island promoter hypermethylation of the Ras-effector gene NORE1A         occurs in the context of a wild-type K-ras in lung cancer.         Oncogene 2004; 23:8695-9.     -   39. Hesson L B, Wilson R, Morton D, Adams C, Walker M, Maher E         R, Latif F. CpG island promoter hypermethylation of a novel         Ras-effector gene RASSF2A is an early event in colon         carcinogenesis and correlates inversely with K-ras mutations.         Oncogene 2005; 24:3987-94.     -   40. Sato F, Harpaz N, Shibata D, Xu Y, Yin J, Mori Y, et al.         Hypermethylation of the p14(ARF) gene in ulcerative         colitis-associated colorectal carcinogenesis. Cancer Res 2002;         62:1148-51.     -   41. Iida S, Akiyama Y, Nakajima T, Ichikawa W, Nihei Z, Sugihara         K, Yuasa Y. Alterations and hypermethylation of the p 14(ARF)         gene in gastric cancer. Int J Cancer 2000; 87:654-8.     -   42. Dominguez G, Silva J, Garcia J M, Silva J M, Rodriguez R,         Munoz C, et al. Prevalence of aberrant methylation of p14ARF         over p16INK4a in some human primary tumors. Mutat Res 2003;         530:9-17.     -   43. Chen W, Wu Y, Zhu J, Liu J, Tan S, Xia C. Methylation of p16         and p15 genes in multiple myeloma. Chin Med Sci J 2002;         17:101-5.     -   44. Yang B, Guo M, Herman J G, Clark D P. Aberrant promoter         methylation profiles of tumor suppressor genes in hepatocellular         carcinoma. Am J Pathol 2003; 163:1101-7.     -   45. Kurakawa E, Shimamoto T, Utsumi K, Hirano T, Kato H,         Ohyashiki K. Hypermethylation of p16(INK4a) and p15(INK4b) genes         in non-small cell lung cancer. Int J Oncol 2001; 19:277-81.     -   46. Liu Z, Wang L E, Wang L, Lu K H, Mills G B, Bondy M L,         Wei Q. 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Anticancer Res 2006; 26:2313-6.     -   51. Fujitake S, Hibi K, Okochi O, Kodera Y, Ito K, Akiyama S,         Nakao A. Aberrant methylation of SOCS-1 was observed in younger         colorectal cancer patients. J Gastroenterol 2004; 39:120-4.     -   52. Ekmekci C G, Gutierrez M I, Siraj A K, Ozbek U, Bhatia K.         Aberrant methylation of multiple tumor suppressor genes in acute         myeloid leukemia. Am J Hematol 2004; 77:233-40.     -   53. Oshimo Y, Kuraoka K, Nakayama H, Kitadai Y, Yoshida K,         Chayama K, Yasui W. Epigenetic inactivation of SOCS-1 by CpG         island hypermethylation in human gastric carcinoma. Int J Cancer         2004; 112:1003-9.     -   54. Sutherland K D, Lindeman G J, Choong D Y, Wittlin S,         Brentzell L, Phillips W, et al. Differential hypermethylation of         SOCS genes in ovarian and breast carcinomas. Oncogene 2004;         23:7726-33.     -   55. Komazaki T, Nagai H, Emi M, Terada Y, Yabe A, Jin E, et al.         Hypermethylation-associated inactivation of the SOCS-1 gene, a         JAX/STAT inhibitor, in human pancreatic cancers. Jpn J Clin         Oncol 2004; 34:191-4.     -   56. Yoshikawa H, Matsubara K, Qian G S, Jackson P, Groopman J D,         Manning J E, et al. SOCS-1, a negative regulator of the JAK/STAT         pathway, is silenced by methylation in human hepatocellular         carcinoma and shows growth-suppression activity. Nat Genet 2001;         28:29-35.     -   57. Chen C Y, Tsay W, Tang J L, Shen H L, Lin S W, Huang S Y, et         al. SOCS1 methylation in patients with newly diagnosed acute         myeloid leukemia. Genes Chromosomes Cancer 2003; 37:300-5.     -   58. Ye Y, Su C, Wang D, Liu S, Liu Y, Liu B, et al. Relationship         between tumor suppressor gene p16 and Rb and early diagnosis of         lung cancers. Zhonghua Wai Ke Za Zhi 2000; 38:537-41, 30.     -   59. Stirzaker C, Millar D S, Paul C L, Warnecke P M, Harrison J,         Vincent P C, et al. Extensive DNA methylation spanning the Rb         promoter in retinoblastoma tumors. Cancer Res 1997; 57:2229-37.     -   60. Esteller M. Epigenetic lesions causing genetic lesions in         human cancer: promoter hypermethylation of DNA repair genes. Eur         J Cancer 2000; 36:2294-300.     -   61. Li H, Lu S, Fong L. Study on the states of methylation of Rb         gene promoter in human esophageal cancer and effect of NMBzA on         Rb gene promoter in monkey esophageal epithelium. Zhonghua Zhong         Liu Za Zhi 1998; 20:412-4.     -   62. Banks R E, Tirukonda P, Taylor C, Hornigold N, Astuti D,         Cohen D, et al. Genetic and epigenetic analysis of von         Hippel-Lindau (VHL) gene alterations and relationship with         clinical variables in sporadic renal cancer. Cancer Res 2006;         66:2000-11.

In accordance with the method of the present invention a sample is taken or obtained from the patient. Suitable samples include blood, plasma, serum, saliva and urine. Samples to be used in accordance with the present invention include whole blood, plasma or serum. Methods for preparing serum or plasma from whole blood are well known among those of skill in the art. For example, blood can be placed in a tube containing EDTA or a specialised commercial product such as Vacutainer SST (Becton Dickenson, Franklin Lake, N.J.) to prevent blood clotting, and plasma can then be obtained from whole blood through centrifugation. Serum may be obtained with or without centrifugation following blood clotting. If centrifugation is used then it is typically, though not exclusively conducted at an appropriate speed, for example, 1500-3000×g. Plasma or serum may be subjected to additional centrifugation steps before being transferred to a fresh tube for DNA extraction.

Preferably, DNA is extracted from the sample using a suitable DNA extraction technique. Extraction of DNA is a matter of routine for one of skill in the art. There are numerous known methods for extracting DNA from a biological sample including blood. General methods of DNA preparation, for example described by Sambrook and Russell, Molecular Cloning a Laboratory Manual, 3^(rd) Edition (2001) can be followed. Various commercially available reagents or kits may also be used to obtain DNA from a blood sample.

In accordance with the invention, the DNA containing sample is incubated with one or more restriction enzyme(s) which preferentially cut unmethylated DNA under conditions such that where two or more restriction enzyme sites are present in the target sequence in the unmethylated state, the restriction enzyme(s) can cut the target sequence at at least one such site. In accordance with an alternative aspect of the invention, a DNA sample is incubated with one or more restriction enzymes which only cut methylated DNA under conditions such that where two or more restriction enzyme sites are present in the methylated state, the restriction enzyme(s) can cut the target sequence at at least one such site.

Preferably samples are incubated under conditions to allow complete digestion. This may be achieved, for example by increasing the incubation times and/or increasing the quantity of the enzyme used. Typically, the sample will be incubated with 100 active units of methylation-sensitive restriction enzyme for a period of up to 16 hours. It is a matter of routine for one of skill in the art to establish suitable conditions based on the quantity of enzyme used.

After incubation, uncut target sequences are detected. Preferably, these sequences are detected by amplification, for example using the polymerase chain reaction (PCR).

DNA primers are designed to amplify a sequence containing at least two methylation-sensitive restriction enzyme sites. Such sequences can be identified by looking at DNA methylation markers and identifying restriction enzyme sites within those markets which are recognised by methylation-sensitive enzymes. For example using the recognition sequences for the methylation-sensitive enzymes identified in Table I, suitable target sequences can be identified in the methylation markers listed in Table III.

Using RASSF1A as an example, the target sequence may comprise part or all of the promoter sequence and/or exon 1 of the RASSF1A gene. The sequence for the promoter and exon 1 is set out in FIG. 6 (SEQ NO: 1). In a preferred embodiment the target sequence for detection is that highlighted in bold in FIG. 6 (residues 1142 to 1269 of SEQ ID NO: 1). In a more preferred embodiment residues 1142 to 1269 of SEQ ID NO: 1 are amplified using (a) a primer comprising or consisting of the sequence shown in SEQ ID NO: 2 and (b) a primer comprising or consisting of the sequence shown in SEQ ID NO: 3. In another more preferred embodiment residues 1142 to 1269 of SEQ ID NO: 1 are detected using a detectably-labelled probe comprising the sequence shown in SEQ ID NO: 4. In an even more preferred embodiment residues 1142 to 1269 of SEQ ID NO: 1 are detected using a detectably-labelled probe comprising the sequence shown in SEQ ID NO: 4 and no additional nucleotides.

When using methylation-sensitive enzymes, altered quantities of the target sequence will be detected depending on the methylation status of the target sequence in a particular individual. In the preferred aspect of the present invention using methylation-sensitive restriction enzymes which preferentially cut unmethylated DNA, the target sequence will not be detected in the unmethylated state, for example in a healthy individual. However, where the target sequence is methylated, for example in a selected sample from a cancer patient, the target sequence is not cut by the restriction enzyme and the target sequence can thus be detected by PCR.

Thus, the method can be used to determine the methylation status of the target sequence and provide an indication of the cancer status of the individual.

The methods of the present invention may additionally include quantifying or detecting a control sequence. The control sequence is selected which does not show aberrant methylation patterns in cancer. In accordance with a preferred aspect of the present invention, the control sequence is selected to contain at least two methylation-sensitive restriction enzyme recognition sites. Preferably, the control sequence is selected to contain the same number of methylation-sensitive restriction enzyme recognition sites as the DNA sequence of interest. Typically the presence or absence of such control sequences is detected by amplification by the polymerase chain reaction after digestion with the methylation-sensitive restriction enzyme(s). Such control sequences can be used to assess the extent of digestion with the one or more methylation-sensitive restriction enzymes. For example, if after digestion with the methylation-sensitive restriction enzyme(s) control sequences are detectable, this would indicate that the digestion is not complete and the methods can be repeated to ensure that complete digestion has occurred. Preferably the control sequence is selected to contain the same methylation-sensitive restriction enzyme sites that are present in the target sequence. In a preferred embodiment the control sequence is β-actin. In a more preferred embodiment a target sequence in the β-actin is amplified using (a) a primer comprising or consisting of the sequence shown in SEQ ID NO: 5 and (b) a primer comprising or consisting of the sequence shown in SEQ ID NO: 6. In an even more preferred embodiment the target sequence in β-actin (which is amplified using primers comprising SEQ NOs: 5 and 6) is detected using a detectably-labelled probe comprising the sequence shown in SEQ ID NO: 7. In an even more preferred embodiment the target sequence is detected using a detectably-labelled probe comprising the sequence shown in SEQ ID NO: 7 and no additional nucleotides.

The present methods can be used to assess the tumor status of an individual. The methods can be used, for example, in the diagnosis and/or prognosis of cancer. The methods can also be used to monitor the progress of cancer, for example, during treatment. The methods can also be used to monitor changes in the levels of methylation over time, for example to assess the susceptibility of an individual to cancer, and the progression of the disease. The methods can also be used to predict the outcome of disease or the likelihood of success of treatment.

In a preferred aspect of the present invention the target sequence is RASSF1A and is used in the diagnosis of cancer. For example, RASSF1A methylation can be used to detect and monitor hepatocellular or nasopharyngeal carcinoma. The method is particularly useful in monitoring the susceptibility of a hepatitis B carrier or a hepatitis C carrier to hepatocellular carcinoma.

In another aspect of the invention, there is provided probes and primers for use in the method of the invention. Firstly, there is provided a set of primers or a detectably-labelled probe for the detection or monitoring of cancer in a biological sample selected from blood, plasma, serum, saliva, urine from an individual. The set of primers comprises or consists of (a) a primer comprising or consisting of the sequence shown in SEQ ID NO: 2 and (b) a primer comprising or consisting of the sequence shown in SEQ ID NO: 3. The set of primers is capable of amplifying residues 1142 to 1269 of SEQ ID NO: 1 (i.e. part of the promoter and first exon of the RASSF1A gene). The detectably-labelled probe comprises the sequence shown in SEQ ID NO: 4 and is capable of detecting residues 1142 to 1269 of SEQ ID NO: 1. The detectably-labelled probe preferably comprises the sequence shown in SEQ ID NO: 4 and no additional nucleotides. The detectably-labelled probe is most preferably the probe used in the Examples.

Secondly, there is provided a set of primers and a detectably-labelled probe for use as a control during the detection or monitoring of cancer in a biological sample selected from blood, plasma, serum, saliva, urine from an individual. The set of primers comprises or consists of (a) a primer comprising or consisting of the sequence shown in SEQ ID NO: 5 and (b) a primer comprising or consisting of the sequence shown in SEQ ID NO: 6. The set of primers is capable of amplifying a target sequence in β-actin. The detectably-labelled probe comprises the sequence shown in SEQ ED NO: 7 and is capable of detecting the target sequence in β-actin that is amplified by the printers comprising SEQ ID NOs: 5 and 6. The detectably-labelled probe preferably comprises the sequence shown in SEQ ID NO: 7 and no additional nucleotides. The detectably-labelled control probe is most preferably the control probe used in the Examples.

The probes are detectably-labelled. The detectable label allows the presence or absence of the hybridization product formed by specific hybridization between the probe and the target sequence to be determined. Any label can be used. Suitable labels include, but are not limited to, fluorescent molecules, radioisotopes, e.g. ¹²⁵I, ³⁵S, enzymes, antibodies and linkers such as biotin.

In another aspect, there is provided kits for use in the method of invention. Firstly, there is provided a kit for the detection or monitoring of cancer in a biological sample selected from blood, plasma, serum, saliva, urine from an individual. The kit comprises (a) a primer comprising or consisting of the sequence shown in SEQ NO: 2, (b) a primer comprising or consisting of the sequence shown in SEQ ID NO: 3 and (c) a detectably-labelled probe comprising the sequence shown in SEQ ID NO: 4 and optionally no additional nucleotides. The kit is capable of amplifying and detecting residues 1142 to 1269 of SEQ ID NO: 1.

Secondly, there is provided a kit for use as a control during the detection or monitoring of cancer in a biological sample selected from blood, plasma, serum, saliva, urine from an individual. The kit comprises (a) a primer comprising or consisting of the sequence shown in SEQ ID NO: 5, (b) a primer comprising or consisting of the sequence shown in SEQ ID NO: 6 and (c) a detectably-labelled probe comprising the sequence shown in SEQ ID NO: 7 and optionally no additional nucleotides. The kit is capable of amplifying and detecting a target sequence in β-actin.

The kits of the invention may additionally comprise one or more other reagents or instruments which enable the method of the invention as described above to be carried out. Such reagents or instruments include one or more of the following: suitable buffer(s) (aqueous solutions), PCR reagents, fluorescent markers and/or reagents, means to obtain a sample from individual subject (such as a vessel or an instrument comprising a needle) or a support comprising wells on which reactions can be done. Reagants may be present in the kit in a dry state such that the fluid sample resuspends the reagents. The kit may, optionally, comprise instructions to enable the kit to be used in the method of the invention.

The invention is hereinafter described in more detail by reference to the Examples below.

EXAMPLES

Sixty-three hepatocellular carcinoma (HCC) patients, as well as two groups of controls, were recruited. The first control group consisted of 15 healthy control subjects without chronic hepatitis B infection. The second control group consisted of chronic hepatitis B carriers. For each HCC patient, one sex- and age-matched chronic hepatitis B carrier was recruited as a control. Chronic hepatitis B carriers had increased risk of developing HCC and, thus, would be the target group for HCC screening. Four milliliters of venous blood were collected from each study subject into EDTA-containing tubes. Blood samples were centrifuged at 1,600 g for 10 min and the supernatant was re-centrifuged at 16,000 g for 10 min. DNA was then extracted from 800 μL of plasma using the QIAamp mini kit (Qiagen, Hilden, Germany) and eluted with 50 μL of H₂O. Thirty-five microliters of plasma DNA were digested with 100 U of BstUI enzyme, in 1× digestion buffer at 60° C. for 16 hours.

The concentration of plasma RASSF1A sequence was determined by real-time PCR using the primers 5′AGCCTGAGCTCATTGAGCTG3′ (SEQ ID NO: 2) and 5′ACCAGCTGCCGTGTGG3′ (SEQ ID NO: 3), and the probe 5′FAM-CCAACGCGCTGCGCAT(MGB)3′ (SEQ ID NO: 4). Each reaction contains 1× TaqMan Universal PCR Master Mix (Applied Biosystems, Foster City), 300 nM each of the primers and 85 nM of probes. 7.15 microliters of enzyme-digested plasma DNA mixture (equivalent to 5 μL of undigested plasma DNA) were used as the template for each PCR reaction. The thermal profile was 50° C. for 2 minutes, 95° C. for 10 minutes, 50 cycles of 95° C. for 15 seconds and 60° C. for 1 minute. All reactions were run in duplicate and the mean quantity was taken. The RASSF1A amplicon embraced 5 restriction sites of BstUI.

To ensure the completeness of the restriction enzyme digestion, real-time PCR targeting the β-actin gene was performed for each enzyme digested samples using the primers 5′ GCGCCGTTCCGAAAGTT3′ (SEQ ID NO: 5) and 5′CGGCGGATCGGCAAA3′ (SEQ ID NO: 6), and the probe 5′FAM-ACCGCCGAGACCGCGTC(MGB)3′ (SEQ ID NO: 7). By bisulfite sequencing, the β-actin gene promoter was shown to be completely unmethylated in blood cells and HCC tissues. The β-actin amplicon is of similar size of the RASSF1A amplicon and contains identical number of BstUI enzyme restriction sites.

To investigate if the enzyme digestion efficiencies for unmethylated RASSF1A and β-actin sequences were similar, aliquots of 1 μg of buffy coat were digested with 100 U of BstUI enzyme for different time intervals (15 minutes, 30 minutes, 45 minutes, 60 minutes, 90 minutes, 120 minutes, 3 hours, 4 hours, 5 hours, 6 hours, 12 hours and 16 hours). The concentrations of RASSF1A and β-actin sequences were measured in each sample after the enzyme digestion. As shown in FIG. 1, the concentrations of RASSF1A and β-actin sequences in these buffy coat DNA showed a positive correlation (r=0.986, P<0.0001, Pearson correlation). As the enzyme digestion efficiencies for unmethylated RASSF1A and β-actin sequences are similar, the completeness of the digestion of unmethylated RASSF1A sequence should be reflected by the absence of β-actin sequence in the digested plasma DNA sample. Therefore, all samples with positive β-actin signal were subject to further enzyme digestion until no β-actin sequence was detectable in the digested plasma DNA sample.

After BstUI enzyme digestion, RASSF1A sequences were detected in the plasma of 59 (93%) of the 63 HCC patients and 37 (58%) of the 63 matched chronic hepatitis B carriers (HBV carriers). These results are shown in FIG. 2. The median plasma RASSF1A concentrations of the HCC patients and chronic hepatitis B carriers were 770 copies/mL and 118 copies/mL, respectively. In contrast, RASSF1A was not detectable in the plasma of any of the 15 healthy subjects.

FIG. 3 demonstrates that the survival probabilities of HCC patients with preoperative plasma RASSF1A concentration of less than 550 copies/mL were better than those with levels higher than 550 copies/mL (p=0.0359, Kaplan-Meier survival analysis).

Blood samples were collected from the HCC patients at 1 month after the surgical resection of the tumor. In the 59 patients with detectable plasma RASSF1A before tumor resection, 45 of them (76%) showed a reduction in the concentration after the operation. These results are shown in FIG. 4. Among these 45 patients, 13 of them had undetectable RASSF1A after the resection of tumor. The median RASSF1A concentration dropped from 770 copies/mL to 250 copies/mL (p<0.0001, Wilcoxon test).

To further investigate if the quantitative analysis of plasma RASSF1A after methylation-sensitive restriction enzyme digestion is a generic marker for cancers with aberrant methylation of RASSF1A, 67 nasopharyngeal carcinoma (NPC) patients were recruited for the study of the correlation of the plasma concentrations of enzyme-digestion-resistant RASSF1A and Epstein-Barr virus (EBV) DNA. Plasma EBV DNA is an established marker for NPC and has been shown to reflect tumor load (Lo Y M D, Chan L Y, Lo K W, Leung S F, Zhang J, Chan A T, Lee J C, Hjelm N M, Johnson P J, Huang D P. Quantitative analysis of cell-free Epstein-Barr virus DNA in plasma of patients with nasopharyngeal carcinoma. Cancer Res 1999; 59:1188-91). The results are shown in FIG. 5. EBV DNA and enzyme-digestion-resistant RASSF1A sequence were detectable in the plasma of 65 (94%) and 37 (54%) patients, respectively. In the patients with detectable enzyme-digestion-resistant RASSF1A and EBV DNA, the plasma concentrations of the two DNA sequences showed a positive correlation (r=0.343, p=0.037, Spearman correlation). 

1.-25. (canceled)
 26. A method for detection, prognostication, or monitoring cancer using a biological sample from an individual, the method comprising: (a) obtaining DNA from the biological sample; (b) digesting the DNA with one or more methylation-sensitive restriction enzymes; (c) detecting a target sequence in the DNA digested in (b), wherein the target sequence comprises at least two methylation-sensitive restriction enzyme recognition sites; and (d) comparing a level of the target sequence from the individual to a normal standard to detect, prognosticate, or monitor the cancer.
 27. The method according to claim 26, wherein the biological sample is selected from the group consisting of blood, plasma, serum, saliva, and urine.
 28. The method according to claim 26, wherein (c) comprises using real-time quantitative polymerase chain reaction (Q-PCR) to generate a PCR amplicon, and wherein the PCR amplicon comprises at least two recognition sites for the one or more methylation-sensitive restriction enzymes used in (b).
 29. The method according to claim 26, wherein (c) comprises using polymerase chain reaction (PCR) to generate a PCR amplicon, and wherein the PCR amplicon comprises at least two recognition sites for the one or more methylation-sensitive restriction enzymes used in (b).
 30. The method according to claim 26, wherein the target sequence in (c) comprises at least a portion of a gene which demonstrates an aberrant DNA methylation pattern in cancer.
 31. The method according to claim 30, wherein the at least the portion of the gene which demonstrates an aberrant DNA methylation pattern in cancer is selected from the group consisting of a promoter, exon 1, and a fragment thereof of RASSF1A.
 32. The method according to claim 30, wherein the at least the portion of the gene which demonstrates an aberrant DNA methylation pattern in cancer comprises residues 1142 to 1269 of SEQ ID NO:
 1. 33. The method according to claim 30, wherein the at least the portion of the gene which demonstrates an aberrant DNA methylation pattern in cancer is amplified using a primer comprising SEQ ID NO: 2 and a primer comprising SEQ ID NO: 3; and/or the target sequence is detected using a detectably-labelled probe comprising SEQ ID NO:
 4. 34. The method according to claim 30, wherein the gene is selected from a group consisting of APC, DAP-kinase, E-cadherin, GSTPI, hMLH1, MGMT, NORE1A, p14, p15, P16INK4a, RARbeta, SOCS1, Rb, and VHL.
 35. The method according to claim 26, wherein following (b), each DNA from the sample is cleaved by at least one methylation-sensitive restriction enzyme when present in an unmethylated state.
 36. The method according to claim 26, wherein in (b) the DNA is treated under conditions sufficient to allow digestion of the DNA by (i) increasing a molar concentration of methylation-sensitive restriction enzyme in a composition comprising the DNA, and/or (ii) extending an incubation time of a composition comprising the DNA.
 37. The method according to claim 26, further using the level of the target sequence to: diagnose cancer in the individual; predict susceptibility to cancer of the individual; assess stage of the cancer in the individual; predict likelihood of overall survival for the individual; predict likelihood of recurrence of cancer for the individual; or assess treatment effectiveness with respect to cancer for the individual.
 38. The method according to claim 37, further comprising quantifying a trend of the level of the target sequence over a time course of treatment, monitoring or post-treatment.
 39. The method according to claim 37, wherein the target sequence comprises at least a portion of RASSF1A, and wherein the level of the target sequence is used in diagnosis, prognosis or monitoring of hepatocellular carcinoma or nasopharyngeal carcinoma.
 40. The method according to claim 39, wherein the individual is a hepatitis carrier.
 41. The method according to claim 40, wherein the individual is a hepatitis B carrier or a hepatitis C carrier.
 42. The method according to claim 26, further comprising quantifying or detecting a control DNA sequence from the biological sample that has been digested with one or more methylation-sensitive restriction enzyme(s), wherein the control DNA sequence does not demonstrate an aberrant DNA methylation pattern in cancer.
 43. The method according to claim 42, wherein the control DNA sequence comprises at least two methylation-sensitive restriction enzyme recognition sites.
 44. The method according to claim 43, wherein the control DNA sequence and the target sequence have a same number of methylation-sensitive restriction enzyme recognition sites.
 45. The method according to claim 42, wherein the control DNA sequence encodes for β-actin.
 46. The method according to claim 45, further comprising subjecting the control DNA sequence to amplification using a primer comprising SEQ ID NO: 5 and a primer comprising SEQ ID NO:
 6. 47. The method according to claim 46, wherein the target sequence is detected using a detectably-labelled probe comprising SEQ ID NO:
 7. 48. The method according to claim 42, further comprising assessing an extent or completeness of enzyme digestion.
 49. The method according to claim 26, wherein the target sequence comprises a tumor suppressor gene.
 50. The method according to claim 49, wherein the tumor suppressor gene comprises RASSF1A.
 51. The method according to claim 26, wherein the cancer is liver cancer. 